Prohibiting the use of foreign aid to provide access to safe abortions has repercussions far beyond US borders

US aid policy still denies women access to abortion if they are raped in war. Photograph: Carolyn Kaster/AP

Over many years, I have visited conflict-affected states where I have met women who have suffered the agony of rape, and where sexual violence is the shocking and specific consequence of conflict.

These women are often traumatised, stigmatised and ostracised by their families and communities. When they are pregnant as a result of rape, these consequences are compounded.

While there is welcome attention focused on the plight of women and girls raped in war, there are still significant gaps in the international response to this global scourge.

One of those critical gaps is the routine denial of access to safe abortion services for rape survivors, which violates their rights under international humanitarian law. The reality is that these women are entitled under the Geneva conventions “to receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition”.

I remember meeting three women in the Democratic Republic of the Congo who had been gang-raped the day before as they walked home from the market. I will never forget them, and I have often wondered what would have happened if they were pregnant, because abortion is illegal in Congo .

What we do know is that, often when women in such situations are denied access to safe abortion services, they resort, in desperation, to unsafe methods that can result in serious harm or even death. And this happens even though several international bodies, including the committee against torture and the human rights committee, have found that the denial of abortion to rape victims can be defined as “torture and cruel, inhuman and degrading treatment”.

So what exactly are the obstacles and restrictions facing them, when it is already clearly defined that when rape is used as a weapon of war, in armed conflict, women have an absolute right to non-discriminatory medical care under the Geneva conventions?

ICRC is the Department for International Development’s (DfID) partner of choice and receives the largest amount of DfID funding made to humanitarian organisations. This means that the UK is severely compromised by restrictions that it apparently doesn’t support, and which allow for a situation where life-saving abortion is being denied, even to very young girls raped in conflict.

This clearly flies in the face of international humanitarian law. In a recent statement, DfID said: “In conflict situations where denying an abortion in accordance with national law would threaten the mother’s life or cause unbearable suffering, international humanitarian law principles may justify performing an abortion”.

Does that mean that when the suffering of an impregnated war rape victim is “bearable” she can be denied an abortion? And how does she prove that her suffering is unbearable?

DfID says it talks to Norway , a country that is showing real leadership and has asked the US to lift the abortion ban as a matter of compliance with the Geneva conventions. Why doesn’t the UK join Norway in the stand it is taking?

And isn’t it time that the UK stood up for the rights of women and girls who have been raped to have the same access to medical treatment as other war victims?

An Idaho federal judge dismissed the charges against McCormack in September 2011 on the grounds that the law cannot be enforced. McCormack then challenged the law itself, arguing that it imposes an undue burden on women’s access to abortion in Idaho.

The Ninth Circuit Court of Appeals ruled Tuesday that the law is likely unconstitutional because the burden of having to adhere to criminal abortion statutes should fall on the physician rather than the pregnant woman.

“There can be no doubt that requiring women to explore the intricacies of state abortion statutes to ensure that they and their provider act within the Idaho abortion statute framework, results in an ‘undue burden’ on a woman seeking an abortion of a nonviable fetus,” Judge Harry Pregerson wrote in his opinion.

The ruling, however, does not mean that other pregnant women can now break the law without fear of being prosecuted, Pregerson said. Until the law is struck down, prosecutors can legally continue to enforce it.

It’s called a “wrongful birth” bill and it’s all about preventing women from having an abortion, even if it kills them. The Arizona Senate passed a bill this week that gives doctors a free pass to not inform pregnant women of prenatal problems because such information could lead to an abortion.

In other words, doctors can intentionally keep critical health information from pregnant women and can’t be sued for it. According to the Arizona Capitol Times, “the bill’s sponsor is Republican Nancy Barto of Phoenix. She says allowing the medical malpractice lawsuits endorses the idea that if a child is born with a disability, someone is to blame.” So Republicans are banning lawsuits against doctors who keep information from pregnant women so as to prevent them from choosing to have an abortion.

This bill is actually more disturbing than the Republicans seem to realize. Giving doctors such a free pass risks the lives of both the expectant mother and the fetus she carries. Prenatal care isn’t just for discovering birth defects and disabilities. It is also for discovering life threatening issues such as an ectopic pregnancy which often requires an abortion to save the life of the mother. With rare exceptions, ectopic pregnancies are not viable anyway, but Republicans are allowing anti-abortion doctors to keep life threatening information from pregnant women all because they are obsessed with stopping any and all abortions. Women may not know they have a life threatening condition until they die on the emergency room table. And the doctor couldn’t be sued.

This is an egregious bill that will lead to higher mortality rates for infants and mothers. Doctors should be held accountable for not disclosing information learned from prenatal examinations. Pregnant women have the right to know if their future child is going to have a disability or if the pregnancy may require an induced abortion to save their lives. Any decision that is made as a result of the information is the mothers own. Doctors should not be allowed to make decisions for pregnant women as a way to prevent abortions. Women have the right to make their own health decisions and hiding critical information is irresponsible, unconscionable, and risks lives. In the end, Republicans are only putting more lives in jeopardy. They might as well call this the ‘let women die’ bill.

Catholic Hospitals Expand, Religious Strings Attached

Published: February 20, 2012

As Roman Catholic leaders and government officials clash over the proper role of religion and reproductive health, shifts in health care economics are magnifying the tension. Financially stronger Catholic-sponsored medical centers are increasingly joining with smaller secular hospitals, in some cases limiting access to treatments like contraception, abortion and sterilization.

Catholic hospitals have a broad mission for medical care, says Sister Carol Keehan, president of the Catholic Health Association.

In Seattle, Swedish Health Services has offered elective abortions for decades. But the hospital agreed to stop when it joined forces this month with Providence Health & Services, one of the nation’s largest Catholic systems.

In late December, Gov. Steve Beshear of Kentucky turned down a bid by Catholic Health Initiatives, another large system, to merge with a public hospital in Louisville, in part because of concern that some women would have less access to contraceptive services.

And in Rockford, Ill., there is resistance to a plan by OSF HealthCare, run by the Sisters of the Third Order of St. Francis, to buy a hospital because of new restrictions that would require women to go elsewhere if they wanted atubal ligation after a Caesarean section.

About 20 such deals have been announced over the last three years, by one estimate, and experts expect more as stand-alone hospitals and smaller systems with no Catholic ties look to combine with larger and financially stronger institutions, in part because changes under the federal health care law are forcing all hospitals to become much more efficient.

There is already considerable tension between Catholic-run medical institutions and the Obama administration over insurance coverage for contraception for employees. The cultural divide over reproductive health is playing out on the campaign trail as candidates debate hot-button issues like abortion and contraception.

But while the growth of Catholic-run hospital networks is a testament to their long history and operational skill, local and state officials, doctors and advocates in many communities are concerned that some procedures that run counter to Catholic doctrine may no longer be available or will be much more limited. Some doctors fear they may not be able to do what’s best for patients, forced to wait to treat a woman who is miscarrying, for example, or to send arape victim elsewhere for an emergency contraceptive.

The restrictions at any given hospital may not be clear. “Women simply don’t know what they’re getting,” said Jill C. Morrison, senior counsel in health and reproductive rights at the National Women’s Law Center.

The confusion is likely to increase.

“We are starting to see what was rare in the past,” said Lisa Goldstein, who follows nonprofit hospitals for Moody’s Investors Service and predicts more such partnerships. The institutions themselves are grappling with how to remain true to Catholic doctrine and serve a broader community. About one-sixth of all patients were admitted to a Catholic hospital in 2010. In many smaller communities, the only hospital within miles is Catholic.

“That is a constant challenge,” said Sister Carol Keehan, president of the Catholic Health Association of the United States, which represents the nation’s roughly 600 Catholic hospitals. “It’s a challenge we take very seriously.”

Being a Catholic hospital means adhering to the church’s religious directives about care, Sister Carol said, but she says hospitals also see their mission much more broadly, including caring for those who are less fortunate and treating patients with respect.

At the Seton Healthcare Family in Texas, a unit of Ascension Health — the nation’s largest Catholic system and largest nonprofit system — officials say partnerships with struggling community hospitals are integral to their mission. Seton’s first partnership, in 1995, was to operate Brackenridge, a public hospital in Austin, because Seton was “not doing enough to care for the poor and vulnerable in central Texas,” said Charles J. Barnett, an Ascension executive.

In that case, Mr. Barnett says the system never agreed to provide services like elective abortions and sterilizations, and public officials and hospital administrators initially struggled to find a compromise. Although another system eventually offered sterilizations on a separate floor of the hospital, complete with a separate elevator, another hospital now provides those services.

One large system, Catholic Healthcare West in San Francisco, announced in January that it was severing its formal ties to the church to better work with hospitals that did not share its faith. The system, renamed Dignity Health, operates 25 Catholic hospitals, which will remain Catholic, and 15 non-Catholic hospitals. While none of Dignity’s hospitals will provide elective abortions or offer in vitro fertilization, the non-Catholic hospitals will not have to adhere to the church’s religious directives.

Dignity officials declined interview requests.

Even as Catholic Healthcare West, however, the system was not without controversy. One of its Catholic hospitals performed what it considered a life-saving abortion in 2009, but the local bishop in Phoenix disagreed, and the nun who allowed the procedure was excommunicated.

In many communities, like Rockford, the question is an intensely practical one: How will patients, particularly women, use services barred by the church? Because none of the city’s three hospitals perform elective abortions, the debate has largely focused on whether a woman who has a C-section can have her tubes tied afterward.

“It would just be an inconvenience to the patient and the physician, who has to make life-and-death decisions,” said Dr. Ronald Burmeister, a retired obstetrician in Rockford who is concerned about the merger.

The merger itself was prompted by the increasing need for hospitals to combine. Despite the federal government’s concern about possible antitrust implications, many believe the city can support just two hospitals. “Rockford needed a strategic partner,” said Andrew K. Bachrodt, a managing director for Kurt Salmon Associates, which advises nonprofit hospitals. OSF already owns a Rockford hospital, OSF Saint Anthony Medical Center.

OSF says Rockford needs fewer hospitals and wants to expand its network to better serve the area. “It’s all about how to deliver care, coordinated and efficient care,” said Robert C. Sehring, an executive at OSF.

OSF has already developed an arrangement in which affiliated doctors can prescribe birth control pills through a separate practice.

A woman who wanted a tubal ligation immediately after a C-section would be able to go to a competing hospital, if her insurance plan allowed. “It’s not like we’re eliminating female sterilization procedures,” said Kris L. Kieper, the chief executive of the YWCA in Rockford, who serves on an advisory committee for the OSF hospital there.

In Louisville, the debate focused on contraceptive services, like elective sterilizations, that had been provided by the University of Louisville Hospital, one member of a planned three-party merger that would have created a large statewide system. There was considerable uncertainty over whether University Hospital would be required to follow Catholic policies, according to a report by the Kentucky attorney general. Officials initially said the hospital would follow Catholic directives but then focused on certain procedures.

“While this evolving explanation may represent an accurate description of the proposed legal structure of the consolidation, it has cast a cloud of vagueness and skepticism over the issue in the public eye,” the report concluded.

Asking women to go across town to another hospital for services is not a solution, said Dr. Peter Hasselbacher, a retired university official who follows health policy in Kentucky. And while women in Louisville generally have a choice of hospitals, women in rural communities may not, he said, adding that many of Catholic Health Initiative’s Kentucky hospitals are the only hospital available.

Catholic Health says there was never a possibility that University Hospital would be allowed to perform services like elective sterilizations. “Our position around the ethical and religious directives never changed. How we communicated that evolved and changed over time,” said Paul Edgett, a senior vice president at the system.

Mr. Edgett says the system will consider future partnerships with non-Catholic hospitals, including University Hospital, as it seeks to position itself as a stronger system as health care evolves. “We all have to adopt and adapt,” he said. But, he added, “we’re not going to compromise our values in the process.”

NEW YORK — The Women’s Media Center is deeply disappointed with the Susan G. Komen for the Cure Foundation’s decision to cease funding breast cancer prevention, education, and screenings at Planned Parenthood health centers. We urge our friends and supporters to join us by standing in solidarity with Planned Parenthood Federation of America and all of the women and families they serve to ensure that almost 750,000 women in rural, underserved, and low-income communities continue to receive comprehensive and accessible preventative care.

The Komen Foundation provides an important voice and services in the movement to find a cure for breast cancer. We applaud them for this work but are troubled by the foundation’s public explanation that the decision to cease funding Planned Parenthood had nothing to do with abortion politics.

Since 2005, the National Right to Life Committee (NRLC) and STOPP (most recently known as the Society To Outlaw Planned Parenthood), have pushed a very public campaign aimed at ending Komen Foundation funding of Planned Parenthood services for breast cancer screening. Dr. John Willke, a former President of the National Right to Life Committee has promoted a STOPP research report about the Komen Foundation support of Planned Parenthood (http://www.lifeissues.org/AbortionBreastcancer/komen/fact_sheet.pdf). In October, 2011, Carol Tobias, the President of the National Right to Life Committee, wrote a column for Legatus Magazine that criticized the Komen Foundation with sentences like, “Komen’s support of the nation’s largest abortion provider is ironic in that, while Komen works to find a cure for breast cancer, Planned Parenthood is providing a “service” that contributes to the increase of breast cancer.” [NOTE: According to the National Cancer Institute at the National Institutes of Health, over 100 of the world’s leading experts have concluded that having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer Summary Report: Early Reproductive Events and Breast Cancer Workshop]

The National Right to Life Committee was originally created by the National Conference of Catholic Bishops and the President of the National Right to Life Committee has a platform and megaphone that extends far beyond the NRLC federation of 50 state right-to-life organizations and 3,000 local chapters nationwide. In light of the public campaign against the Komen Foundation by the anti-choice movement, it is difficult to understand how the decision by the Komen Foundation is not related to abortion politics.

From a media perspective, the enormous outcry by women everywhere on Twitter, Facebook and blogs indicates the Foundation’s media team and leadership miscalculated the public’s reaction to their decision. Politico reports that in a video posted yesterday, Nancy Brinker, the founder and CEO of the Komen Foundation, said that the decision had been “mischaracterized” and that “the scurrilous accusations being hurled at this organization are profoundly hurtful.” (http://www.politico.com/news/stories/0212/72360.html)

The Women’s Media Center is a pro-choice organization and fully supports the movement to find a cure for breast cancer.

The Women’s Media Center urges the Susan G. Komen for the Cure Foundation to respond to press inquiries about the long-time anti-choice campaign for the Komen Foundation to stop funding Planned Parenthood to clarify that there was in fact no connection between a highly orchestrated anti-choice campaign and the decision of the Komen Foundation to end its support of Planned Parenthood for breast cancer prevention, education, and screenings. The firestorm from this decision is not going to go away until the obvious links and questions are fully discussed.

It’s been almost three years since President Obama repealed the global gag rule, one of the most ludicrous and paternalistic U.S. foreign policies in history. But as we celebrate the anniversary of its repeal, just one day after the anniversary of Roe v. Wade on January 22nd, another matter deserves our attention.

The last stronghold of America’s oppressive overseas reproductive health policies, the Helms Amendment, is still alive and well. The 1973 amendment to the Foreign Assistance Act restricts U.S. funding for abortion overseas – even in countries where abortion is legal. Specifically, it states:

“No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.”

The Helms Amendment invented what the global gag rule caricatured: a foreign policy that explicitly intrudes on the lives of women in developing countries, singling out and stigmatizing ‘abortion’ from the continuum of reproductive care necessary for a healthy life. Yet we’ve heard relatively little of this “grandfather” of anti-choice policies over the past 40 years, and all the while its colonial specter has continued to haunt the United State’s legacy of global reproductive rights.

“We are concerned that the Helms Amendment – which restricts but does not prohibit abortion funding – is being implemented as though it were an absolute ban,” the letter stated.

The letter is a first step toward addressing a policy that has undermine the rights and health of women throughout the world for far too long.

Although Helms prohibits U.S. aid from directly supporting abortion services, it is supposed to allow for the provision of abortion counseling and referrals, post-abortion care, and abortion in cases of rape, incest, and danger to the life of the woman. Years of careful tracking and documentation work on the part of reproductive rights groups, spearheaded by Ipas and the Center for Reproductive Rights (CRR) have produced clear evidence that in reality, these exceptions exist in theory but not in practice.

“Despite provisions allowing foreign-assistance funding for abortion services under certain circumstances, for almost 40 years the Helms Amendment has been implemented improperly as a total ban on all abortions,” CRR said in a statement released last month.

If this sounds eerily familiar, it should. While the gag rule has been officially rescinded, it seems the Helms Amendment has continued to function in effectively the same way. Primarily due to the clumsy wording of the amendment (what constitutes “abortion as a method of family planning” and what counts as “motivating” abortion?), and the long history of the use of women’s rights to full reproductive health care as a political football, application of the policy in-country among aid workers and recipients has veered drastically toward banning and self-censorship. Ipas and CRR, along with a small group of legislators, are asking President Obama to issue clarifying guidance to ensure the proper implementation of the policy.

The groups suggest that the Helms Amendment has contributed to an overall environment of censorship, stigma, and misinformation around abortion, resulting in barriers to services and consequent deaths and injuries. For example, Nepal’s abortion law was liberalized in 2002. Yet Ipas found that despite this, and even after the repeal of the global gag rule, abortion was omitted entirely from formal USAID trainings, discussions, and manuals, and abortion groups were informally excluded from partner meetings on national reproductive health strategies.

As abortion is singled out, reproductive health services become fragmented, drastically reducing the likelihood that women will receive these services at all even under “legal” circumstances. The situation is not likely to be much better in any other country receiving U.S. international assistance, including countries where rape is being regularly employed as a weapon of war. This is disturbing when you consider that global aid funding is supposed to “help” in the most fundamental way, not harm. Unsafe abortion remains a leading cause of maternal mortality in the developing world, and that is clearly thanks in part to the Helms Amendment.

This seems to be something that everyone should care about. That the Helms Amendment exists in the first place should incite reproductive (and human) rights advocates – it is ties assistance to an ideology that flouts medical and scientific evidence and the reality of women’s lives. It should further incite us that this policy is being twisted to create additional obstacles for women in some of the most vulnerable places in the world. Yet the Helms Amendment remains a policy largely un-touched by pro-choice groups and rarely covered in the media.

The Hyde Amendment, which is basically the domestic version of the Helms Amendment, turned 35 just months ago, an anniversary that provided an opportunity to highlight the unjust, classist, and oppressive nature of a policy that most deeply affects low-income women in the United States. The coverage was terrific and widespread, delving into the history and implications of the policy, and even providing a helpful framework of lessons for activists. Yet in all this, Helms was barely mentioned.

This is disappointing and problematic, because the two are so intimately connected. The Congressional letter to President Obama begins, “We are Members of Congress committed to reproductive rights at home and abroad…”. That line, at home and abroad, is pivotal. These policies do not exist in a vacuum, and neither do the anti-woman ideologies propelling them and keeping them in place. Their inceptions were related and if advocates are to successfully repeal them, those efforts, too, may have to be related.

Recent efforts to drag the Helms Amendment into the light come at a critical time. Last month, the administration announced an historic National Plan of Action on Women, Peace, and Security, an executive order that puts women at the center of U.S. foreign policy. President Obama has talked the talk, now he is being asked to walk the walk. The president can ask the relevant agencies to review their policies and make guidance on the Helms Amendment and its exceptions crystal clear. He can issue an executive order ensuring that funding streams are not burdened by overly broad interpretations of an already-heninous law. The decision is in the Administration’s hands. It is too soon to know what the outcome will be, but it seems at least the wheels may be starting to turn.

At the end of last year the Senate blocked the Shaheen Amendment to the 2012 National Defense Authorization Act, which would have restored insurance coverage of abortion for women serving in the military who are raped—giving military women the same benefits that federal employees, women enrolled in Medicaid, and women in federal prison receive.

The lack of support for this bill is shocking given the high rates of sexual assault and rape in the military that put the nearly 300,000 women serving in the US military (97 percent of whom are of reproductive age) at increased risk for unintended pregnancy. While the Shaheen Amendment would have been an important step forward in ensuring comprehensive health care for servicewomen, our research at Ibis Reproductive Health has documented a number of other gaps in access to reproductive health care that also need to be addressed. We urge policymakers in 2012 to put politics aside and support the women serving our country through policies that meet their needs and promote their health and well-being.

Servicewomen need access to abortion in military medical facilities to ensure safe, confidential, and timely access to care

In addition to military insurance not covering abortions except in cases where the servicewoman’s life is in danger, current federal policy also prohibits abortions from being performed in military facilities overseas even if a woman pays for it herself, with narrow exceptions for life endangerment, rape, and incest.

In a recent study we conducted with military women and dependents seeking abortion during overseas deployment, women with an unintended pregnancy overwhelmingly wanted to complete their tour of duty and continue serving their country, and did not want to interrupt their service by returning home because of the pregnancy. The majority, however, were stationed in countries where abortion is prohibited, such as Iraq and Afghanistan, where abortion is banned except to save the life of the woman.

Women furthermore reported difficulties leaving their military bases due to combat operations and other unsafe conditions that limited their mobility. In the face of these obstacles to in-country abortion care, they had to leave to return to the US for an abortion. These circumstances adversely affect the ability of the woman’s unit to accomplish its mission, and a soldier’s travel to the United States for an abortion also delays access to this time-sensitive procedure, creates confidentiality concerns, and can negatively affect the soldier’s career.

We found that even in circumstances of rape, when women should, under current law, be entitled to abortion services at military facilities (if they pay for it themselves), many servicewomen were still seeking to terminate their pregnancy outside of the military system because they feared their account of the rape would not be believed and that the pregnancy could negatively affect their careers. More efforts are needed to ensure that servicewomen who experience military sexual trauma receive the timely care and support that they need and deserve. Moreover, military policies prohibiting or discouraging sexual activity during deployment create an environment of fear for some women, and the military should instead emphasize making reproductive health services, including the full range of contraceptive methods and abortion care, available rather than punishing the women (and men) who have unintended pregnancies.

Servicewomen need access to the full range of contraceptive methods for deployment

According to a literature review we recently published, U.S. military women experience higher rates of unintended pregnancy than women of reproductive age in the US overall, and though this may in part be due to disproportionate numbers of young women serving in the military, these rates signal health care needs that are not being met. Our research on the experiences of US military women seeking health care during deployment has found that women face a number of challenges to accessing contraceptives during deployment. Preliminary results from an online survey and telephone interviews with servicewomen show that women do not get routine counseling about contraceptive options as part of pre-deployment preparations; they do not always have access to the full range of contraceptive methods—in particular IUDs—for deployment; and they face challenges getting refills and consistently using their method during tours of duty.

Servicewomen should be able to access the full range of reproductive health care services so that they can decide if and when to have children, and can lead safe, healthy reproductive lives during and after their military service. All women in the military need to know about and have access to the full range of contraceptive methods and abortion services during overseas deployment, when they may have no other source of health care than military medical facilities. Allowing abortions to be provided in military medical facilities (and ideally be covered by military insurance to prevent financial barriers) would ensure safe, timely access to abortion care—either in-country or on a military base in the United States.

Improved reproductive health care access during deployment would not only meet the needs of servicewomen, but also help promote troop readiness, ensuring women who serve their country can do their jobs and that their units do not suffer their absences any longer than necessary. Finally, it is critical that sexual assault in the military continues to be addressed and that sexual assault survivors have access to high-quality prevention and treatment services.

Women in the military serve their country with distinction and protect our rights. We should support their rights and health, and ensure they have access to the reproductive health information, services, and products they need.